Temporomandibular Joint Dysfunction (Jaw pain)
Temporomandibular joint (TMJ) disorders are fairly common and can involve jaw, face and head pain as well as clicking and locking of the jaw.
It can affect anybody but is commonly seen in young women.
It can be broadly classified into 2 types, myofascial and internal derangement. Myofascial problems can involve the ligament, muscle, fascia, joint lining or nerves. Internal derangement problems involve the joints and discs in the TMJ.
The TMJ has ligaments, muscles, capsule and discs of cartilage like many joints in the body. It has 2 compartments (upper and lower) which allow the complex movements of eating and talking to occur.
Gliding and sliding movements occur in the upper compartment and rotation and hinge movements occur in the lower compartment. The disc that sits between the 2 compartments is partly controlled by the Pterygoid muscles which also controls side to side movement and stability.
The Maseter and Temporalis are the other main muscles that work with the Pterygoids to produce the numerous movements of the TMJ.
Myofascial
There can be many factors contributing to this type of TMJ problem including bruxism (teeth grinding), loss of teeth or poor tooth alignment and psychological disorders. Stress can be a large factor as it produces tension in the muscles through jaw clenching, which can lead to muscle fatigue and painful trigger points. Poor posture (especially slouching with your chin forward) can also lead to pressure on the TMJ muscles and joints, as they are unable to work correctly.
Derangement
These causes are related to joint and disc pathology either as a result of diseases such as rheumatoid arthritis, osteoarthritis or gout or from congenital factors like altered joint surface or disc shape.
- Clicking/popping/snapping sensation in the TMJ especially after yawning or eating tough food
- Grating noises when eating or talking
- Headache and neck ache are common
- Face and ear pain
- Loss of movement – unable to open mouth wide
- Locking – the jaw becomes stuck in a position and it is usually very painful if this happens
- Altered tongue position at rest
Red areas in diagram indicate common sites for pain in TMJ patients.
Derangement disorders may require assessment by an Oral Surgeon, as displaced or very damaged discs may need trimming in surgery.
In less severe cases a steroid injection may help reduce inflammation and provide pain relief.
Most patients will benefit from conservative treatments that can be provided by a specialist physiotherapist. Pain relief can involve the use of heat or ice, ultrasound and over the counter painkillers. Specific massage and stretches can reduce pressure on the muscles and relieve painful trigger points. Acupuncture can also be very beneficial, especially in patients who have been suffering for a long time or have other factors involved (anxiety, depression).
If teeth grinding or clenching at night exacerbate the problem, an occlusal splint (type of mouth guard) can be made by a dentist, which prevents the jaws ability to clamp shut. Psychological assessment and support may also be helpful to discover any underlying stress or anxiety that could be contributing to the clenching/teeth grinding.
